Clin Colon Rectal Surg 2013; 26(01): 047-055
DOI: 10.1055/s-0033-1333661
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Simulation and Its Role in Training

Hoda Samia
1   Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
,
Sadaf Khan
1   Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
,
Justin Lawrence
1   Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
,
Conor P. Delaney
1   Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
› Author Affiliations
Further Information

Publication History

Publication Date:
04 March 2013 (online)

Abstract

Despite its short history, surgical simulation has been successfully introduced into surgical residency programs in an effort to augment training. A wide range of simulator types and levels of complexity have proven an effective teaching method for surgical trainees. They have been used for training in areas such as general surgery, urology, gynecology, and ophthalmology among others. Coincident with the introduction of simulators is the need for objective evaluation of skills learned on them, which has led to the development and validation of multiple evaluation tools. This article evaluates the drivers for simulation, types of simulators, training, and evaluation of them especially as it pertains to laparoscopic colorectal surgery.

 
  • References

  • 1 Itani KMF, DePalma RG, Schifftner T , et al. Surgical resident supervision in the operating room and outcomes of care in Veterans Affairs hospitals. Am J Surg 2005; 190 (5) 725-731
  • 2 Mahmoud A, Ward C, Padmesh H, Daher M. Safety and feasibility of the teaching assistant role of senior surgical residents: a prospective randomized study. J Surg Educ 2012; 69 (2) 249-252
  • 3 Maeda T, Tan K-Y, Konishi F , et al. Trainee surgeons do not cause more conversions in laparoscopic colorectal surgery if they are well supervised. World J Surg 2009; 33 (11) 2439-2443
  • 4 Ko CY, Escarce JJ, Baker L, Sharp J, Guarino C. Predictors of surgery resident satisfaction with teaching by attendings: a national survey. Ann Surg 2005; 241 (2) 373-380
  • 5 Bell Jr RH, Biester TW, Tabuenca A , et al. Operative experience of residents in US general surgery programs: a gap between expectation and experience. Ann Surg 2009; 249 (5) 719-724
  • 6 Bass BL. Matching training to practice: the next step. Ann Surg 2006; 243 (4) 436-438
  • 7 Pugh CM, Darosa DA, Bell Jr RH. Residents' self-reported learning needs for intraoperative knowledge: are we missing the bar?. Am J Surg 2010; 199 (4) 562-565
  • 8 Stein S, Stulberg J, Champagne B. Learning laparoscopic colectomy during colorectal residency: what does it take and how are we doing?. Surg Endosc 2012; 26 (2) 488-492
  • 9 Tekkis PP, Senagore AJ, Delaney CP. Conversion rates in laparoscopic colorectal surgery: a predictive model with, 1253 patients. Surg Endosc 2005; 19 (1) 47-54
  • 10 Bennett CL, Stryker SJ, Ferreira MR, Adams J, Beart Jr RW. The learning curve for laparoscopic colorectal surgery. Preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomies. Arch Surg 1997; 132 (1) 41-44 , discussion 45
  • 11 Karamanoukian RL, Ku JK, DeLaRosa J, Karamanoukian HL, Evans GRD. The effects of restricted work hours on clinical training. Am Surg 2006; 72 (1) 19-21
  • 12 Kort KC, Pavone LA, Jensen E, Haque E, Newman N, Kittur D. Resident perceptions of the impact of work-hour restrictions on health care delivery and surgical education: time for transformational change. Surgery 2004; 136 (4) 861-871
  • 13 Agachan F, Joo JS, Sher M, Weiss EG, Nogueras JJ, Wexner SD. Laparoscopic colorectal surgery. Do we get faster?. Surg Endosc 1997; 11 (4) 331-335
  • 14 Perino A, Cucinella G, Venezia R, Castelli A, Cittadini E. Total laparoscopic hysterectomy versus total abdominal hysterectomy: an assessment of the learning curve in a prospective randomized study. Hum Reprod 1999; 14 (12) 2996-2999
  • 15 Schlachta CM, Mamazza J, Seshadri PA, Cadeddu M, Gregoire R, Poulin EC. Defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum 2001; 44 (2) 217-222
  • 16 Aggarwal R, Ward J, Balasundaram I, Sains P, Athanasiou T, Darzi A. Proving the effectiveness of virtual reality simulation for training in laparoscopic surgery. Ann Surg 2007; 246 (5) 771-779
  • 17 Park J, MacRae H, Musselman LJ , et al. Randomized controlled trial of virtual reality simulator training: transfer to live patients. Am J Surg 2007; 194 (2) 205-211
  • 18 Moulton CA, Regehr G, Lingard L, Merritt C, Macrae H. Operating from the other side of the table: control dynamics and the surgeon educator. J Am Coll Surg 2010; 210 (1) 79-86
  • 19 Moulton CA, Regehr G, Lingard L, Merritt C, MacRae H. Slowing down to stay out of trouble in the operating room: remaining attentive in automaticity. Acad Med 2010; 85 (10) 1571-1577
  • 20 Moulton CA, Regehr G, Lingard L, Merritt C, Macrae H. 'Slowing down when you should': initiators and influences of the transition from the routine to the effortful. J Gastrointest Surg 2010; 14 (6) 1019-1026
  • 21 Thompson JR, Leonard AC, Doarn CR, Roesch MJ, Broderick TJ. Limited value of haptics in virtual reality laparoscopic cholecystectomy training. Surg Endosc 2011; 25 (4) 1107-1114
  • 22 Bidarkar SS, Deshpande A, Kaur M, Cohen RC. Porcine models for pediatric minimally invasive surgical training—a template for the future. J Laparoendosc Adv Surg Tech A 2012; 22 (1) 117-122
  • 23 Fried GM, Feldman LS, Vassiliou MC , et al. Proving the value of simulation in laparoscopic surgery. Ann Surg 2004; 240 (3) 518-525 , discussion 525–528
  • 24 Thijssen AS, Schijven MP. Contemporary virtual reality laparoscopy simulators: quicksand or solid grounds for assessing surgical trainees?. Am J Surg 2010; 199 (4) 529-541
  • 25 Kelly DC, Margules AC, Kundavaram CR , et al. Face, content, and construct validation of the Da Vinci Skills Simulator. Urology 2012; 79 (5) 1068-1072
  • 26 Ericsson KA, Nandagopal K, Roring RW. Toward a science of exceptional achievement: attaining superior performance through deliberate practice. Ann N Y Acad Sci 2009; 1172: 199-217
  • 27 Crochet P, Aggarwal R, Dubb SS , et al. Deliberate practice on a virtual reality laparoscopic simulator enhances the quality of surgical technical skills. Ann Surg 2011; 253 (6) 1216-1222
  • 28 Seymour NE, Gallagher AG, Roman SA , et al. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 2002; 236 (4) 458-463 , discussion 463–464
  • 29 Sroka G, Feldman LS, Vassiliou MC, Kaneva PA, Fayez R, Fried GM. Fundamentals of laparoscopic surgery simulator training to proficiency improves laparoscopic performance in the operating room-a randomized controlled trial. Am J Surg 2010; 199 (1) 115-120
  • 30 Kolozsvari NO, Feldman LS, Vassiliou MC, Demyttenaere S, Hoover ML. Sim one, do one, teach one: considerations in designing training curricula for surgical simulation. J Surg Educ 2011; 68 (5) 421-427
  • 31 Vassiliou MC, Kaneva PA, Poulose BK , et al. How should we establish the clinical case numbers required to achieve proficiency in flexible endoscopy?. Am J Surg 2010; 199 (1) 121-125
  • 32 Stefanidis D, Korndorffer Jr JR, Sierra R, Touchard C, Dunne JB, Scott DJ. Skill retention following proficiency-based laparoscopic simulator training. Surgery 2005; 138 (2) 165-170
  • 33 Stefanidis D, Korndorffer Jr JR, Markley S, Sierra R, Scott DJ. Proficiency maintenance: impact of ongoing simulator training on laparoscopic skill retention. J Am Coll Surg 2006; 202 (4) 599-603
  • 34 Edelman DA, Mattos MA, Bouwman DL. FLS skill retention (learning) in first year surgery residents. J Surg Res 2010; 163 (1) 24-28
  • 35 Parmar S, Delaney CP. The role of proximate feedback in skills training. Surgeon 2011; 9 (Suppl. 01) S26-S27
  • 36 Kettle KL, Häubl G. Motivation by anticipation: expecting rapid feedback enhances performance. Psychol Sci 2010; 21 (4) 545-547
  • 37 Aggarwal R, Crochet P, Dias A, Misra A, Ziprin P, Darzi A. Development of a virtual reality training curriculum for laparoscopic cholecystectomy. Br J Surg 2009; 96 (9) 1086-1093
  • 38 Panait L, Bell RL, Roberts KE, Duffy AJ. Designing and validating a customized virtual reality-based laparoscopic skills curriculum. J Surg Educ 2008; 65 (6) 413-417
  • 39 Palter VN, Graafland M, Schijven MP, Grantcharov TP. Designing a proficiency-based, content validated virtual reality curriculum for laparoscopic colorectal surgery: a Delphi approach. Surgery 2012; 151 (3) 391-397
  • 40 Darzi A, Smith S, Taffinder N. Assessing operative skill. Needs to become more objective. BMJ 1999; 318 (7188) 887-888
  • 41 Gallagher AG, Ritter EM, Champion H , et al. Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Ann Surg 2005; 241 (2) 364-372
  • 42 LeBlanc F, Champagne BJ, Augestad KM , et al; Colorectal Surgery Training Group. A comparison of human cadaver and augmented reality simulator models for straight laparoscopic colorectal skills acquisition training. J Am Coll Surg 2010; 211 (2) 250-255
  • 43 Bréaud J, Chevallier D, Benizri E , et al. The place of simulation in the surgical resident curriculum. The pedagogic program of the Nice Medical School Simulation Center. J Vis Surg 2012; 149 (1) e52-e60
  • 44 Zendejas B, Cook DA, Hernández-Irizarry R, Huebner M, Farley DR. Mastery learning simulation-based curriculum for laparoscopic TEP inguinal hernia repair. J Surg Educ 2012; 69 (2) 208-214
  • 45 Lee JY, Mucksavage P, Kerbl DC, Huynh VB, Etafy M, McDougall EM. Validation study of a virtual reality robotic simulator—role as an assessment tool?. J Urol 2012; 187 (3) 998-1002
  • 46 Phitayakorn R, Marks JM, Reynolds HL, Delaney CP. Expert benchmark for the GI Mentor II. Surg Endosc 2009; 23 (3) 611-614
  • 47 Ho VP, Trencheva K, Stein SL, Milsom JW. Mentorship for participants in a laparoscopic colectomy course. Surg Endosc 2012; 26 (3) 722-726
  • 48 Leblanc F, Senagore AJ, Ellis CN , et al; Colorectal Surgery Training Group. Hand-assisted laparoscopic sigmoid colectomy skills acquisition: augmented reality simulator versus human cadaver training models. J Surg Educ 2010; 67 (4) 200-204
  • 49 Nugent E, Hseino H, Boyle E , et al. Assessment of the role of aptitude in the acquisition of advanced laparoscopic surgical skill sets: results from a virtual reality-based laparoscopic colectomy training programme. Intl J Colorectal Dis 2012; . Available at: http://www.ncbi.nlm.nih.gov/pubmed/22526754 . Accessed May 17, 2012
  • 50 Mittal MK, Dumon KR, Edelson PK , et al. Successful implementation of the American College of Surgeons/Association of Program Directors in Surgery Surgical Skills Curriculum via a 4-week consecutive simulation rotation. Simul Healthc 2012; . Available at: http://www.ncbi.nlm.nih.gov/pubmed/22374186 . Accessed May 17, 2012
  • 51 Pitzul KB, Grantcharov TP, Okrainec A. Validation of three virtual reality Fundamentals of Laparoscopic Surgery (FLS) modules. Stud Health Technol Inform 2012; 173: 349-355
  • 52 Kassab E, Tun JK, Arora S , et al. “Blowing up the barriers” in surgical training: exploring and validating the concept of distributed simulation. Ann Surg 2011; 254 (6) 1059-1065
  • 53 Doumouras AG, Keshet I, Nathens AB, Ahmed N, Hicks CM. A crisis of faith? A review of simulation in teaching team-based, crisis management skills to surgical trainees. J Surg Educ 2012; 69 (3) 274-281
  • 54 Peckler B, Prewett MS, Campbell T, Brannick M. Teamwork in the trauma room evaluation of a multimodal team training program. J Emerg Trauma Shock 2012; 5 (1) 23-27
  • 55 Steinemann S, Berg B, Skinner A , et al. In situ, multidisciplinary, simulation-based teamwork training improves early trauma care. J Surg Educ 2011; 68 (6) 472-477
  • 56 Satava RM, Hunter AM. The surgical ensemble: choreography as a simulation and training tool. Surg Endosc 2011; 25 (9) 3080-3086
  • 57 Kassab ES, King D, Hull LM , et al. Actor training for surgical team simulations. Med Teach 2010; 32 (3) 256-258
  • 58 Powers KA, Rehrig ST, Irias N , et al. Simulated laparoscopic operating room crisis: an approach to enhance the surgical team performance. Surg Endosc 2008; 22 (4) 885-900
  • 59 Vassiliou MC, Feldman LS, Andrew CG , et al. A global assessment tool for evaluation of intraoperative laparoscopic skills. Am J Surg 2005; 190 (1) 107-113
  • 60 Gumbs AA, Hogle NJ, Fowler DL. Evaluation of resident laparoscopic performance using global operative assessment of laparoscopic skills. J Am Coll Surg 2007; 204 (2) 308-313
  • 61 Vaillancourt M, Ghaderi I, Kaneva P , et al. GOALS-incisional hernia: a valid assessment of simulated laparoscopic incisional hernia repair. Surg Innov 2011; 18 (1) 48-54
  • 62 Martin JA, Regehr G, Reznick R , et al. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 1997; 84 (2) 273-278
  • 63 Faulkner H, Regehr G, Martin J, Reznick R. Validation of an objective structured assessment of technical skill for surgical residents. Acad Med 1996; 71 (12) 1363-1365
  • 64 Ishman SL, Brown DJ, Boss EF , et al. Development and pilot testing of an operative competency assessment tool for pediatric direct laryngoscopy and rigid bronchoscopy. Laryngoscope 2010; 120 (11) 2294-2300
  • 65 Swift SE, Carter JF. Institution and validation of an observed structured assessment of technical skills (OSATS) for obstetrics and gynecology residents and faculty. Am J Obstet Gynecol 2006; 195 (2) 617-621 , discussion 621–623
  • 66 Miskovic D, Ni M, Wyles SM, Parvaiz A, Hanna GB. Observational clinical human reliability analysis (OCHRA) for competency assessment in laparoscopic colorectal surgery at the specialist level. Surg Endosc 2012; 26 (3) 796-803
  • 67 Verdaasdonk EGG, Dankelman J, Lange JF, Stassen LPS. Transfer validity of laparoscopic knot-tying training on a VR simulator to a realistic environment: a randomized controlled trial. Surg Endosc 2008; 22 (7) 1636-1642
  • 68 Beyer L, Troyer JD, Mancini J, Bladou F, Berdah SV, Karsenty G. Impact of laparoscopy simulator training on the technical skills of future surgeons in the operating room: a prospective study. Am J Surg 2011; 202 (3) 265-272
  • 69 Anastakis DJ, Regehr G, Reznick RK , et al. Assessment of technical skills transfer from the bench training model to the human model. Am J Surg 1999; 177 (2) 167-170
  • 70 Torkington J, Smith SG, Rees BI, Darzi A. Skill transfer from virtual reality to a real laparoscopic task. Surg Endosc 2001; 15 (10) 1076-1079
  • 71 Miskovic D, Wyles SM, Carter F, Coleman MG, Hanna GB. Development, validation and implementation of a monitoring tool for training in laparoscopic colorectal surgery in the English National Training Program. Surg Endosc 2011; 25 (4) 1136-1142
  • 72 Palter VN, Grantcharov TP. A prospective study demonstrating the reliability and validity of two procedure-specific evaluation tools to assess operative competence in laparoscopic colorectal surgery. Surg Endosc 2012; . Available at: http://www.ncbi.nlm.nih.gov/pubmed/22476826 . Accessed May 17, 2012
  • 73 Sarker SK, Kumar I, Delaney C. Assessing operative performance in advanced laparoscopic colorectal surgery. World J Surg 2010; 34 (7) 1594-1603
  • 74 Sanfey HA, Dunnington GL. Basic surgical skills testing for junior residents: current views of general surgery program directors. J Am Coll Surg 2011; 212 (3) 406-412